The ability to achieve leg or arm lengthening with bone lengthening has created new opportunities in the treatment of many congenital or acquired leg-arm inequalities. Treatment of the common problem of dwarfism is now possible with bone lengthening surgeries. Congenital shortness of bones in the arms and legs is defined as dwarfism if it is below 1.30 centimeters in adult males and 1.25 centimeters in females. In dwarfism, while joint functions are normal, the arms and legs are symmetrically and similarly short. Such disorders can be eliminated to a great extent and results that the patient and his/her relatives will be happy with can be achieved.
Üsküdar University NPISTANBUL Hospital Orthopedics and Traumatology Specialist Prof. Dr. Ahmet Fatih Parmaksızoğlu stated that orthopedic disorders and dwarfism due to bone shortness in the legs and arms can be eliminated with successful operations.
Bone lengthening is possible for aesthetic and medical purposes
Stating that bone lengthening operations are performed for two different purposes, Orthopedics and Traumatology Specialist Prof. Dr. Ahmet Fatih Parmaksızoğlu said, "The primary purpose of these operations is to eliminate the difference between leg lengths caused by various reasons. It is divided into two as medical and aesthetic, but it is an important criterion that the patient who wants for aesthetic purposes experiences short stature as a serious problem in his life and is psychologically evaluated. We can define bone lengthening for aesthetic purposes as an individual who has no orthopedic problems and only applies with the concern of short stature. For us, the lengthening we do for medical reasons is important. This is because there is a serious orthopedic problem. We try to overcome this orthopedic problem and ensure the patient's adaptation to normal life."
Bone lengthening can be performed between the ages of 3 and 60
Parmaksızoğlu said that individuals in the patient group with some orthopedic problems may have one of the bones below the knee shorter than the other from the moment they are born and continued his words as follows; "These are really serious problems. The child and the family are seriously affected and this situation is perceived as helpless. It is possible to make these legs functional close to normal if certain conditions are met. The results of the applications we have made for this are really promising. I advise families not to immediately accept the amputation suggestions offered to them, but to do research and see if we can create a lower limb that can meet the daily needs of the child more functionally. Although it sometimes seems like a very hopeless picture, with some miracle surgeries, tissue transplants and bone extensions, it is possible to achieve a structure that gives much better results than a prosthesis, and of course much more useful because it belongs to its own body. We can perform medical bone lengthening operations in patients from 3 years old to 60 years old."
Organ loss is a big problem in our geography
Stating that it is normal for patients to accept when they visit several doctors and encounter suggestions for prosthesis, Parmaksızoğlu said, "Since it is not possible to go back in amputation, it is necessary to investigate whether there is a functional organ that can be obtained until the last point. When an amputation is performed, that is, when that faulty, damaged organ is removed, there is no other option but prosthesis. With the techniques we have such as tissue transplants, lengthening surgeries, nerve transfers, it is possible to make those limbs much better compared to prosthesis."
Parmaksızoğlu continued his words as follows: "In some cases, prostheses are inevitable, we think like our other colleagues when there is really nothing to do. In some cases, when the patient comes, we state that we will apply the techniques we have so that it does not turn into amputation, but we also state that we may be forced to amputation or prosthesis at any point. We have not encountered such a situation so far, but we consider it among the possibilities. We think we have gained a good experience as we do it."
Dwarfism will no longer be a problem
Referring to the solution of the problem of dwarfism, which we frequently encounter in society, Prof. Dr. Ahmet Fatih Parmaksızoğlu expressed his views as follows: "We characterize dwarfism as a problem that comes with birth and creates a great burden on the child and the family. If we accept developmental delay below 1.50, we can say that 1.30 for boys and 1.25 for girls is the limit for dwarfism. There are two types of dwarfism. The first one is proportional, meaning that all the limbs in the body are in harmony with each other. We can consider it as the smallest of a normal person. The other is defined as disproportionate dwarfism. Here, there are problems due to congenital damage or lack of activity at the growth points of bones such as arms and legs. In disproportionate dwarfism, it is necessary to perform lengthening surgeries after the age of 5. It is possible to achieve an acceptable appearance with an average of 3 lengthening operations."
We have a patient with a bone length of 32 centimeters
Talking about the process of bone lengthening operation medically and stating that they have performed successful operations, Parmaksızoğlu said, "When we decide to lengthen the bone, we place a nail in it if there is a channel through which it can pass. If there is no such channel, we cannot use nails. Then we put a device from outside. There are areas in the bone that are suitable for elongation, we break it by cracking it with low energy from the appropriate place so as not to disrupt the integrity. Then we rotate the device half a turn in the morning and half a turn in the evening every day. In this process, the bones that are stuck together slowly start to separate from each other. We can provide 1 millimeter a day, 1 centimeter in ten days, and 3 centimeters in 1 month. If we want 6 centimeters of lengthening, we continue this operation for 60 days. While the bones are separated from each other during rotation, this application initiates a great healing process in the bone. The body itself fills the gaps between the bones."
While Parmaksızoğlu continued his words about the operation process, he also talked about the sample case: "We extend it, we wait, it heals, we put pressure on it, that is, we test its strength. The bone becomes stronger and in that process, it is already back to normal. If we have divided the lengthening into how many periods, we apply these tests between each period. We start lengthening again as if we had never lengthened it. After a certain period of time, problems may start with soft tissue tensions due to prolongation. We stop and wait, lock the system, ossification is completed, we walk, and when the bones get stronger in this process, we start again. There are nerves, veins, muscles in the limb, and all of them adapt to that tension as we slowly lengthen it every day. We get very good results from these operations. We have a girl with congenital abnormality whom we lengthened 32 centimeters in 4 separate operations. She and her family are very happy. The bone of one foot was congenitally short. We brought her foot to the position to use it. We brought the two feet to the same position and reset the problem by extending 32 centimeters in 4 operations, roughly 8 centimeters in each extension. Theoretically, there is no limit to this extension. If desired, we can go up to 32 centimeters if needed."
Normal life continues during the treatment process
Prof. Dr. Ahmet Fatih Parmaksızoğlu said that the patients who undergo bone lengthening surgery receive physiotherapy treatment in this process. "Although the operation seems big, it is the same as the condition of a patient with a broken leg. During the bone lengthening operation, patients can travel with crutches and continue their daily lives. They just need to be very careful about bathing until they remove the device. If we can place a nail in the bone, we can shorten the time by half."
Aesthetic operation is simpler
Saying that there are patients who apply with short stature despite not having any orthopedic problems, Parmaksızoğlu continued his words as follows; "They do not seem to have any orthopedic problems that affect their movements and life, but because of their short stature, they worry about it and ask if it is possible to lengthen their height. It is technically possible. The operation is easier than other patients because they have not undergone severe traumas, do not have adherent limbs, vascular and nerve problems and we work with very healthy tissues.